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How can hygienists ‘straighten up’?

Offering patients information about orthodontic treatment will help the practice.
Keverly Sugden, RDH, BASDH

Keverly Sugden, RDH, BASDH

Wed. 17 March 2010

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Hygienists are the health drivers for the dental practice. We are very fortunate to be able to create lasting relationships with our patients. We see our patients many times per year. At each visit, we perform comprehensive oral cancer examinations, thorough periodontal examinations and caries screenings. We listen to our patients’ questions, educate and motivate. We recommend and explain treatment and listen to our patients’ wants and desires. Many patients want straight, white teeth, but they do not discuss this with the dentist.

The hygienist can open up a dialogue with the patient about desired treatment by asking a few simple questions. When you ask the patient, “Would you like straighter teeth?” this can lead to much information about the patient and his or her dental desires.

Hygienists understand proper occlusion and can identify malocclusion and explain this to the patient. Dental hygienists play a very important role in identifying patients that require orthodontic treatment, and we are often the first ones to recognize when a patient has an orthodontic problem.

We often see the havoc that improper alignment and crowding have on a patient’s overall oral health.

Ortho 101

The American Association of Orthodontists recommends that all children receive orthodontic check-ups no later than age 7. An early orthodontic checkup enables the orthodontist to determine if permanent teeth will be crowded and result in bite problems.

Early treatment can preserve or create space for erupting teeth and correct harmful oral habits.

Hygienists need to understand orthodontic appliances and technologies so they can effectively explain treatment and the benefit of orthodontic treatment to their patients. Many orthodontists offer seminars to hygienists and this is a great way to learn about new techniques in orthodontics.

Many general dentists are offering Invisalign to their patients, and this is another awesome opportunity for hygienists to learn about orthodontics.

Dentists and orthodontists have to be certified to perform Invisalign treatment. More than 70 per cent of U. S. orthodontists offer Invisalign.

Invisalign treatment involves clear, customized aligners that can straighten teeth with fewer visits than traditional orthodontics. The aligners are unnoticable, comfortable, removable and effective.

One thing patients always ask about is time and price. Traditional orthodontics can take between 15 and 30 months and Invisalign takes 9 to 15 months.

There are many types of systems available for traditional orthodontics. Orthodontic patients can now customize their look with multicolored bands, clear bands or the traditional metal brackets. Teens and children like the idea of having a choice and creating their own personal style. Brackets come in gold, ceramic and stainless steel.

There are various types of appliances that are also used with traditional orthodontics. Head gear is used on patients with an overbite. The headgear gently restricts forward growth of the maxillary teeth. The Herbst Appliance is used on younger, growing patients and reduces the overbite by encouraging the lower jaw forward and the maxillary molars backward.

The palatal expander puts gentle pressure on the maxillary molars and expands the palate. Positioners are clear, plastic appliances that complete traditional orthodontics and are an interim treatment between braces and a retainer. Retainers can be fixed or removable and hold the teeth in position when orthodontics has been completed. Seperators are small rubber bands that are placed before braces to space the teeth and ready them for brackets.

Hygiene after ortho treatment

Hygienists continue their role with the orthodontic patient by providing home care instruction and products for preventative care. Orthodontic patients are at a very high risk for demineralization, the dreaded white spots.

White-spot lesions are the earliest microscopic evidence of enamel caries. Once saliva pH reaches 5.5 or lower, acid begins to dissolve the enamel. Teens are one of the main age groups in braces and one of the main groups to use sports drinks and sodas. These beverages have a pH almost as low as battery acid: their pH is about 2.3 and battery acid is 1.0.

There are many types of remineralization products. MI Paste or MI Paste Plus, available through GC America, combines amorphous calcium phosphate (ACP) and casein phosphopeptide-amorphous calcium phosphate CPP-ACP, also known as Recaldent™.

Tricalcium phosphate, TCP, is available in Clinpro 5000. Calcium sodium phospho-silicate is also available in many professional and over-the-counter products. Fluoride and remineralization products should be used in combination in orthodontic patients to prevent white spot lesions.

Xylitol is another necessity for orthodontic patients. Xylitol reduces the bacteria that cause caries. Xlear manufactures the Spry Dental Defense System that contains an oral rinse, toothpaste, oral mist, mints and gum.

A final word

Orthodontic patients face challenges in home care and maintaining gingival health. Electric toothbrushes, such as Sonicare by Phillips and Oral-B by Braun, are excellent products that make for easier and more effective homecare for the orthodontic patient. Water-pik by Teledyne and the in-shower H20 irrigator are both very useful home care tools as well.

Adults, teens, children and parents need to understand periodontal disease and the destructive effect of periodontal bacteria. OralDNA manufactures a saliva test, MyPerioPath, that determines the patient’s periodontal bacteria. The dentist and hygienist can then recommend antibiotic therapy to reduce these bacteria.

Remember, orthodontic patients have invested heavily in their mouths and they want a pretty smile after treatment. We owe it to our patients to explain, educate and motivate about technologies, treatments and products that will make their orthodontic treatment a success.

Of course, it goes without saying that hygienists need to do a thorough periodontal examination on all patients. Technologies like the DentalR.A.T. 2.0, developed by hygienist Becky Logue, make periodontal charting easier by incorporating a foot pedal that can be used while doing computerized periodontal charting. (You can get more information at www.dentalrat.com.) Also, American Eagle Instruments (www.am-eagle.com) offers lightweight, ergonomic instrument handles with XP technology tips that stay sharp.

About the author

Keverly Sugden RDH, BASDH, is an author, speaker and practicing dental hygienist. She is also an adjunct faculty member at State College of Florida. Sugden is a member of the American Dental Hygiene Association, a vice president for her local component and works with local legislators on access to care for children. She has written a training program for large group dental practices and has organized corporately sponsored continuing education courses for dental hygienists. Sugden can be contacted at keverlysugden@yahoo.com.

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